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Updated: Aug 15, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Ultra-sonic nebulizers as a potential source of methicillin-resistant Staphylococcus aureus causing an outbreak in a
C Schultsz1, H H M Meester, A M H Kranenburg
1Department of Medical Microbiology and Infection Control, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. schultsz@hcm.vnn.vn
Abstract:
An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred on a head and neck surgical (HNS) ward of a university hospital in Amsterdam. The outbreak lasted from May 2000 until November 2000, and MRSA spread to two intensive care units. Amplified fragment length polymorphism analysis indicated that a single clone was responsible for the outbreak. Phage-typing indicated that this clone was of a type that was uncommon in The Netherlands. Strict isolation of patients, according to the Dutch national guidelines, was instituted. During the outbreak, surveillance culture specimens, from patients, healthcare workers, and the environment, were obtained at regular intervals. MRSA was found in the dust filters of nebulizers through which air from the room was filtered and subsequently humidified. These nebulizers were used to humidify tracheostomies. The dust filters were not maintained according to the guidelines. Restricted use and cleaning and disinfection of all ultra-sonic nebulizers led to termination of the outbreak. The outbreak illustrates that to terminate transmission of outbreak strains of MRSA, meticulous measures are necessary, which not only include strict isolation precautions, but also decontamination of the environment. In addition, it demonstrates the necessity of adhering to cleaning and disinfection guidelines for all medical and nursing equipment used in the hospital.
Insights
A methicillin-resistant Staphylococcus aureus (MRSA) outbreak on a surgical ward was traced to contaminated nebulizer filters. Strict environmental decontamination and equipment maintenance ended the transmission of this resistant bacteria.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred in a university hospital.
- The outbreak affected a head and neck surgical ward and spread to intensive care units.
- The causative MRSA strain was identified as a single, uncommon clone.
Purpose of the Study:
- To investigate the source and transmission routes of the MRSA outbreak.
- To identify the factors contributing to the prolonged MRSA transmission.
- To evaluate the effectiveness of control measures in terminating the outbreak.
Main Methods:
- Amplified fragment length polymorphism (AFLP) and phage-typing were used to characterize the MRSA strain.
- Surveillance cultures were collected from patients, healthcare workers, and the hospital environment.
- Environmental sampling focused on nebulizer dust filters used for tracheostomies.
Main Results:
- A single MRSA clone, uncommon in the Netherlands, was responsible for the outbreak.
- MRSA was detected in the dust filters of ultrasonic nebulizers used for tracheostomy humidification.
- Non-adherence to maintenance guidelines for nebulizer filters was identified as a key issue.
- Restricted use and thorough cleaning/disinfection of nebulizers terminated the outbreak.
Conclusions:
- Environmental contamination, particularly of medical equipment like nebulizers, can drive MRSA transmission.
- Strict adherence to cleaning and disinfection guidelines for all medical equipment is crucial.
- Effective MRSA outbreak control requires both patient isolation and thorough environmental decontamination.
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